Moving from diagnosis to explanation

In the previous step we introduced the case of Omar, who has presented with a sensation of something being intermittently stuck at the back of his throat. As pathological causes have been excluded, we are starting to look for other explanations for Omar’s symptoms. For example, could Omar be experiencing a stress-related swallowing problem¹?

This would fall under the umbrella of Medically Unexplained Symptoms (MUS).

MUS can be defined as persistent bodily complaints for which adequate examination (including investigation) doesn’t reveal sufficient explanatory structural or other specified pathology.

So how should we approach patients with MUS?

Knowledge work is key to approaching patients with MUS

Back to our case study…

Take your mind back to Omar, who has requested a re-referral to ENT for another opinion. He is seeking a cure, but by combining what we know about his symptoms and previous medical investigation, the problem is unlikely be caused by a medical pathology to be fixed, but is a consequence of multiple elements, including the stress of feeling unwell. Therefore, we need to work to reframe his problem and manage it differently.

The challenge is no longer about diagnosis, but explanation, to support health for daily living.

In the following sections we will introduce you to two tools which can help you support patients like Omar in future…

1. The flipped consultation

2. Being a gatekeeper

References

1. Jones D, Prowse S. Globus pharyngeus: an update for general practice. BJGP. 2015; 65 (639): 554-555. DOI: 10.3399/bjgp15X687193
2. Haller H, Cramer H, Lauche R, Dobos G. Somatoform disorders and medically unexplained symptoms in primary care. Dtsch Arztebl Int. 2015; 112(16):279-87.
3. Chew-Graham CA, Heyland S, Kingstone T, Shepherd T, Buszewicz M, Burroughs H, Sumathipala A. Medically unexplained symptoms: continuing challenges for primary care. Br J Gen Pract. 2017; 67(656): 106-107. DOI: 10.3399/bjgp17X689473